4-H Meeting/Program/Activity Request

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As we navigate through Covid-19, all in-person meetings and programs held on behalf of Cooperative Extension (once the reopening of 4-H has happened), must receive County Extension Director approval. Please complete this form for each in-person meeting or program, regardless of number of attendees or meeting location.

-This form should be filled out at least a week before your 4-H event.

-You cannot host your 4-H event until approval has been given to you from the County Extension Director.

Email *

Name of 4-H Volunteer making this request: *

Name of 4-H meeting/program/activity: *

Date of 4-H meeting/program/activity: *

YYYY

Beginning and End time of 4-H meeting/program/activity: *

Meeting location (name of location and address): *

Projected number of youth attendees: *

Projected number of adult attendees: *

Describe event space and entrance/exits. *

Describe access to hand washing with soap & water. *

How will social distancing (at least 6 feet distance between each participant) be incorporated and enforced? *

Describe any other PPE (personal protective equipment) and/or sanitization plans. *

Please share any additional comments that may assist the County Extension Director in making a decision about approving this event.

A copy of your responses will be emailed to the address you provided.

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